Indications and complications of bronchoscopy: an experience of 100 cases in a tertiary care hospital

To enlist the frequency of indications and complications of flexible fibreoptic bronchoscopy in a tertiary care hospital. A total of 100 patients admitted to Chest and medical units of Lady Reading hospital Peshawar who needed bronchoscopy were selected irrespective of their age, sex, occupation. All patients in whom bronchoscopy was indicated were included in the study. After detailed clinical history with thorough physical examination and relevant investigations, Bronchoscopy was performed with Olympus fibreoptic bronchoscope. Relevant data were recorded for analysis. Out of 100 patients, 64 [64%] were male, and 36 [36%] were female. Majority of patients [55%] were above 50 years of age. In 60% patients, there was radiographic abnormality on chest X-ray and C.T scan. In 25 [25%], the indication was unexplained hemoptysis and 2 [2%] patients had hoarseness. Another 13 [13%] patients were bronchos coped to see Acid Fast Bacilli in bronchial wash. These patients were suspected to have Tuberculosis but sputum smears were reported negative on repeated examinations. Complications which occurred in these patients included Pneumothorax [1%], hemorrhage [1%], hypoxemia [4%], Atrial tachycardia [3%], bronchospasm [2%], and post-bronchoscopy fever [2%]. These complications were managed accordingly and all patients recovered without any serious consequences. Most of the indications for Bronchoscopy in this hospital are diagnostic rather than therapeutic. Most common indications include radiographic abnormalities, hemoptysis, hoarseness and for isolation of ABF

Survey of chest specialists and trainees knowledge and practice of TB guidelines

To investigate the fundamental knowledge of TB guidelines and their application in day to day practice by the chest specialists and trainees working in teaching hospitals. A questionnaire-based survey was conducted among the participants of 5th biennial chest conference. The data of 195 doctors was analyzed. 96% of doctors said they were treating their TB patients according to guidelines and categorize their patients for treatment, but only 54% knew the correct number of categories for treatment as recommended by the guidelines. Only 49% knew about the components of DOTS. 85% doctors considered sputum microscopy most important diagnostic test for TB and 61% would use it for monitoring of their patients. 88% would advise sputum AFB culture and sensitivity in suspected cases of suspected drug resistance, 59% doctors would treat MDR TB patients themselves and 33% would refer to specialized centers. 5 declared them incurable. 47% and 30% doctors respectively recommended changes in WHO recommended fixed drug combination FDC during pregnancy and lactation. 58% doctors recommended chemoprophylaxis for tuberculosis in our setting. Overall fundamental knowledge of consultants regarding management of TB was good. Knowledge about DOTS and TB guidelines among all the doctors was average and needs improvement. Management of MDR TB by trainees is alarming in the absence of adequate knowledge and experience

Survey of awareness and management attitudes of chest specialist and trainees towards asthma

The study was aimed at three objectives: i. To know about doctors understanding of pathophysiology of Asthma. ii: To assess the knowledge of treatment of asthma and actual treatment practices by Chest specialists and Postgraduate trainees. iii: To assess the baseline knowledge, attitude and treatment practice in the absence of any local treatment guidelines and then see the effectiveness of the guidelines in changing their practice. A preset questionnaire was distributed among doctors from all over Pakistan, during 5th Biennial Conference on Lung Health in 2002. Each question was followed by a set of answers, of which one was to be tick marked. 66 doctors participated, 14 teaching consultants, 24 chest specialists, 14 postgraduate students, and 14 other doctors. 82% doctors would treat their patients on long-term basis and 18% would treat them acutely. 71% thought asthma was chronic inflammation of the airways whereas 28% thought it was due to bronchoconstriction and mucus plugging. Airways remodeling was considered to be partially or fully reversible by 90% and not reversible by 8%, 2% did not respond. 89% were fully aware of stepwise management of asthma and 11% were little aware. The grading of asthma severity was done by clinical examination 44% and clinical plus spirometery 56%. Inhalers were prescribed always by 35%, frequently by 57% and sometimes by 6%. 78% prescribed steroid inhalers alone or in combination with Beta 2 agonist, whereas 12% used only Beta 2 agonist. 93% would teach inhaler technique by themselves or by trained technician and 7% would leave it to chemists or patients. 88% would check inhaler technique on follow-up visit. 92% used oral drugs with inhalers. The choice of oral drugs varied between steroid [8%], theophylline [28%], Beta 2 agonist [37%], and leukotriene inhibitors [18%], no response [9%]. 47% sometimes and 50% never advised desensitization while 3% recommended it frequently. A significant proportion of doctors lacked a good understanding of pathophysiology of asthma. Although the majority of chest physicians and trainees were fully aware and correctly practiced, a significant number [i.e. one fourth] of doctors were not managing their patients with asthma correctly according to the guidelines